Surgical procedures often involve the apposition of tissues with the use of sutures or other devices, such as metallic clips or staples. Reconstructive surgical procedures depend on the permanent approximation of tissues, usually with the use of nonabsorbable suture material. In pelvic reconstructive surgery, for example, several approaches are commonly used to treat various types of pelvic support defects, including cystocele, rectocele, enterocele, uterine prolapse or vaginal vault prolapse after hysterectomy. Abdominal or laparoscopic surgery may be used to elevate the urethra or bladder, the uterus or vaginal vault. Sutures may be placed under the vaginal epithelium in order to suspend the vagina to supporting structures, such as the pelvic side wall, the arcus tendineous fascia pelvis, the sacrospinous ligament, Uterosacral ligament, Cooper's ligament, the pubic symphysis or the anterior longitudinal ligament of the sacral promontory. Vaginal reconstructive surgery may utilize some of the same supporting structures, although the vaginal wall must be opened either anteriorly, posteriorly or apically, in order to place the suspending sutures under the vaginal epithelium. Although vaginal surgery is associated with decreased morbidity, length of stay and recovery compared with abdominal surgery, there is evidence that it may lead to greater denervation and increased rates of recurrent prolapse and need for reoperation. There exists a need in reconstructive and other types of surgery to create a system whereby tissues may be approximated in a minimally-invasive and automated fashion.